Clinical Application And Effect Observation Of VSD In The Treatment Of Gas Gangrene

BACKGROUND: Gas gangrene is one of the serious complications of open wound,that is a severe acute specific infection.Only 1000 to 3000 cases per year are reported in the United States.It is a rare and deadly infection that progresses very rapidly.The disease is caused by the pathogen of clostridium species,which is called Clostridium Sporogenes,due to the shape of bacteria like rod.The reproduction of clostridium is needed in the ischemia and hypoxia environment.So,the patient who suffer from hypovolemic shock and associated with open wound will be susceptible to infection by Clostridium.Traditional treatment methods include: surgical treatment,antibiotic therapy,hyperbaric oxygen therapy and supportive treatment.But the incubation of gas gangrene is short,and rapid advance of course,and the gas gangrene has no obvious specific expression in the early stage.The patient will be amputation even death,if the patient suffer from the disease.Increasingly extensive application in recent years the vacuum sealing drainage technology,what is very suitable for the treatment of the wound,but combined hydrogen peroxide with VSD to treat traumatic gas gangrene has been reported in the literature rarely rare.OBJECTIVE: According to principle of vacuum sealing drainage that can control infection and promote wound healing,to treat gas gangrene.To explore feasibility study of combining the feasibility of hydrogen peroxide with VSD to treat gas gangrene,and retrospectively analyze the clinical effect of treating gas gangrene by VSD.METHOD: Retrospective analysis from July 2015 to January 2018.5 patients who suffered from gas gangrene,4 cases were males,1 cases were females,with age of 28 to 84.All patients underwent debridement after diagnosis.The specific method is as follows: During the operation,the wound should be fully exposed,all necrotic muscle tissue should be cleaned,and the wound should be washed repeatedly with saline,hydrogen peroxide,and dilute iodophors.The VSD foam is cut to the size of the wound after cleaning the wound.Some patients with deep wounds need to be filled with VSD foam and placed into lavage tubes and drainage tubes.After the patient returned to the ward,VSD was connected to the central negative pressure device to maintain continuous negative pressure drainage,which was adjusted to between 17 KPa and 60 KPa.At the same time,the sensitive antibiotic treatment should be chosen according to the bacterial culture results of the patient.The wound should be treated with 3% hydrogen peroxide and normal saline at a ratio of 1:5 and continuous oxygen(4L/min).The negative pressure should be kept and the drainage tube should be opened.The treatment period of VSD is generally 5-7 days.After the patient returned to the ward,he was connected to the central negative pressure device to maintain continuous negative pressure drainage,which was adjusted to between 17 KPa and 60 KPa.RESULT: After 5 cases of gas gangrene with 2 to 6 periods(4 periods on average)of VSD therapy,the infection of all cases was controlled,and wound bacterial culture return no bacterial growth,at the same time hemoglobin,red blood cells,white blood cells and calcitonin were both restored to normal.CONCLUSION: VSD makes up for the deficiency of many traditional methods,can quickly control infection,and promote the growth of granulation tissue and shorten the course of disease.The VSD is an good method in the treatment of gas gangrene and is worthy of clinical use.